Abstract: Heart transplantation is the main treatment of end-stage heart failure. With the advancement of heart transplantation and rational use of postoperative immunosuppressants, the survival rate of recipients has been gradually enhanced. However, a variety of central nervous system complications may still occur following heart transplantation, including immunosuppressant-associated neurotoxicity, epilepsy, stroke, encephalopathy, central nervous system infection and de novo malignant tumors in the central nervous system. These complications will severely affect the quality of life of heart transplant recipients. Consequently, prompt imaging diagnosis plays a significant role in the prevention and treatment of central nervous system complications. In this article, main imaging manifestations of central nervous system complications after heart transplantation were reviewed, aiming to provide reference for prompt diagnosis and differential diagnosis of complications, guide clinical treatment and management, and improve the long-term prognosis of the recipients.